Pediatric Syphilis

  • Etiology: Transplacental infection by Treponema pallidum spirochete which is disseminated throughout fetus causing symmetrical involvement of enchondral ossification sites
  • Imaging Radiograph:
    — Periostitis of long bones is bilateral, symmetrical, diffuse, mild to severe
    — Osteitis – localized to diffuse
    — Metaphysis – dense or lucent or alternating, serrations, exuberant callus, Wimberger corner sign of focal proximal tibia is metaphyseal lucency or notch on proximal medial tibial metaphysis due to destruction
  • DDX:
  • Complications: 33% stillborn, 33% contract syphilis, 33% unaffected, may or may not be symptomatic at birth,
  • Treatment:
  • Clinical:
    — 66% present at 1-2 months and 100% present by 3 months
    — Early congenital syphilis presentation: Prematurity, hepatosplenomegaly, jaundice, nasal chondritis (runny nose), generalized lymphadenopathy, maculopapular rash
    — Late congenital syphilis presentation: Saddle nose, sabre shin, frontal bossing, Hutchison’s triad of Hutchison’s teeth and interstitial keratitis and cranial nerve VIII deafness

Radiology Cases of Syphilis

Radiograph of osteomyelitis due to syphilis
AP radiograph of the lower extremities shows bilateral diffuse periostitis of the tibiae and some destructive changes on the medial proximal metaphysis of the left tibia (Wimberger’s sign).
Radiograph of Wimberger's sign in syphilis
AP radiograph of the lower extremity shows diffuse periostitis of the tibia and some destructive changes on the medial proximal metaphysis of the tibia (Wimberger’s sign).
Radiograph of syphilis
AP radiographs of the bilateral lower extremities show diffuse, thick, symmetric periosteal reaction bilaterally. There is a suggestion of a metaphyseal notch on the proximal medial right tibial metaphysis (Wimberger corner sign).
Radiograph of syphilis of long bones
AP radiograph of the knee at presentation (left) shows faint periostitis of the distal femur and proximal tibia and fibula. There is a metaphyseal lucency present along the proximal portion of the medial aspect of the tibial metaphysis (Wimberger corner sign). Repeat radiograph obtained 2 months later while on therapy (right) shows dense periostitis of the bones with resolution of the lesion previously seen on the proximal medial tibial metaphysis.
Radiograph of syphilis osteomyelitis
AP radiograph of the lower extremities shows diffuse periosteal reaction and cortical thickening and bowing of the bilateral femora and tibae and fibulae.